A total of 20 hospital trusts gain the lowest possible rating of 'weak' on both counts, with four doing badly two years in a row.

An inspection team will be sent to the worst performing, including the heavily criticised Royal Cornwall Hospitals Trust, which is deep in debt.

The others area Northern Devon, Surrey and Sussex, West Hertfordshire Hospitals.

Performance ratings for all NHS Trusts in England for 2006/07 published today also show a North/South divide, with better services in the North compared with areas in central England, the South East and South West.

While there are improvements, the assessment shows major problems remain at some trusts despite record funding poured into the NHS.

The Healthcare Commission, which earlier this month exposed the scandal of 90 deaths caused by the C.Diff bug at Maidstone General Hospital, Kent, found 44 out of 172 acute hospital trusts did not comply with at least one of three basic standards on infection control.

These include high standards of cleanliness, policies on handwashing, staff training, isolation facilities for infected patients and sterilisation of hospital equipment.

Despite growing concern, 56 per cent of hospital trusts failed to meet targets to cut MRSA rates by 40 per cent last year, with nine trusts failing two years running.

Official figures show the national reduction in deadly superbug infections stands at just 10 per cent.

He has also ordered NHS chief executive David Nicholson to meet the four worst performing trusts which could face takeovers unless they improve.

Mr Johnson said Trusts who did not clean up their act could be placed under special measures.

He said Good cleanliness and hygiene are non-negotiable. We have, and will continue to improve the way the NHS works to make sure everyone is safe.'

His intervention came after clashes in the Commons between the Prime Minister and Tory leader David Cameron who blamed 'top down' Government targets for a rise in hospital acquired infections.

Mr Cameron said almost one in two hospitals agree that targets are getting in the way of infection control, backed by the National Audit Office and the Public Accounts Committee.

In recent months MRSA deaths had quadrupled and C.diff deaths had tripled, he said.

'If we are going to deal with hospital acquired infections, you've got to listen to the people who work in the NHS' he demanded.

Gordon Brown said the Government had pledged an extra £100 million to combat MRSA and C.diff.

He said 'very special measures' already announced included MRSA screening of hospital patients going into hospital, deep cleaning of wards, 3,000 more matrons and isolation wards.

The Commission's chief executive Anna Walker said trust boards should never use Government targets as an excuse for risky hygiene practices.

She said 'We recognise that patients are genuinely frightened of catching a superbug in hospital.

'Although most patients receive safe and effective care in the NHS, the risk of suffering an infection is higher than it should be. 'Budgets and targets are not an excuse for failing to keep people safe.' Paul Cann, director of policy at Help the Aged said the Government's measures were 'too little, too late' for many older people being put at risk by poor levels of cleanliness.

He said 'People hope to go into hospitals to get better - regrettably too many older people are contracting potentially devastating illnesses while on the ward.

'More investment must be made into NHS cleaning and powers given to workers and nurses to discipline cleaning contractors and others who are failing on hygiene should be significantly strengthened to protect our older population.'

Across the country, the health check shows improvements in waits for cancer patients, A&E waiting targets and falls in cancelled operations after reorganisation last year slimmed down the total number of trusts from 570 to 394.

Mental health trusts were most improved and did best, compared with acute and specialist trusts and ambulance trusts, while primary care trusts did worst.

Trusts were rated on two key measures of quality of services and financial management, with 19 scoring excellent on both measures - up from two last year.

Altogether 46 per cent of trusts were awarded the top ratings of excellent or good, while 45 per cent were 'fair' and eight per cent were 'weak' for quality of services.

On financial management, 37 per cent of trusts were excellent or good - up from 16 per cent last year - while 62 per cent were fair or weak.

Overall, 111 trusts (44 acute trusts, 58 PCTs, six mental health trusts and three ambulance trusts) were judged to have not met one or more infection control measures - including 12 whose original self-declaration of compliance was overturned on inspection.

Foundation trusts - which have more control over their budgets and management - performed better than other trusts.

The Commission said it was 'disappointed' more trusts had not moved out of the 'fair' category this year, while 20 trusts were rated as 'weak' on both key measures.

Shadow Health Secretary Andrew Lansley said 'Despite extra funding the NHS still faces significant difficulties such as the failure to reduce MRSA and to meet core standards on infection control.'

Liberal Democrat Norman Lamb MP said 'Progress on Government targets must not come at the expense of the most important priority of all: clean hospitals free from infection.

'This report shows that many hospitals are still not protecting patients from the threat of superbugs.'

The health check does not include Wales, while Scotland or Northern Ireland have their own bodies.